Gastro esophageal reflux is the reflux of food and/or stomach acid into the esophagus. It can be considered normal for this escape to occur up to 10 times a day and last less than four minutes, especially in the lying position and immediately after meals, as intra-gastric pressure increases. However, if it occurs more than 10 times a day and for longer than four minutes, or if there is damage to the esophagus due to this leakage, it is called gastroesophageal reflux disease (GERD). It is a common clinical picture (in approximately 20% of the population) and is the most common cause of non-cardiac chest pain.
How Does GERD Occur?
Normally, stomach contents and bile pass into the esophagus. If there is some leakage, our body has some defense mechanisms to eliminate it:
• The esophagus enters the stomach at an angle, not as a straight pipe. However, there is a muscle layer that prevents the food from coming out, and this muscle layer contracts after the food enters the stomach and prevents it from falling back. Even if it escapes, it is sent back to the stomach thanks to these peristaltic movements. • Saliva neutralizes the acidity of the escaping foods and prevents the damage they will cause in the esophagus. If there are factors that increase stomach pressure, such as liver disease, liver cirrhosis and acid, then GERD occurs.
What are the symptoms of GERD?
Bitter water coming into the mouth,
On the stomach or Pain under the bone in the middle of the chest that can spread to the jaw and throat, burning and fullness sensation and chest pain,
Bitter, sour acid taste in the throat,
Chronic irritating cough, resistant upper respiratory tract infections,
Symptoms If there are symptoms such as increased after eating and when lying down,
upper digestive system bleeding, it should be investigated.
Diagnostic Methods
If the patient has symptoms that suggest GERD, whether the disease is present or not. not It may be necessary to perform one or more of the following examinations to detect the disease and the damage it causes: • Esophageal Passage Radiograph; By having a barium morsel swallowed. It is the taking of serial films during the swallowing process. It is the first examination that should be performed in all patients with swallowing difficulties.
• Endoscopy; It is the examination of the esophagus with an endoscope (gastroscope). It provides information about the cause of the complaint and the extent of damage to the esophagus. • Esophageal Manometry; It is a test that measures the movements of the esophagus. It shows whether the esophagus works sufficiently to send the food to the stomach after the bite is swallowed.
• 24-hour pHmetry monitoring; It is a test that shows acid spurts and the duration of acid retention for 24 hours, fixing the esophagus inserted through the nose at 5cm above the lower end.
Side Effects of GERD; It disrupts the comfort of the person by creating chest pain and discomfort behind the chest.
Acid may escape into the throat and cause frequent upper respiratory tract infections, hoarseness, irritant cough, asthma.
It may cause a bad odor in the mouth and throat and tooth decay.
It may cause changes called Barrett's esophagus, which can be a precursor to cancer, in 1% of cases with GERD that lasts more than five years.
Stenosis due to damage caused by acid content in the lower part of the esophagus (in approximately 10% of patients). and swallowing difficulties may occur.
GERD Treatment:
Treatment should be examined under three main headings.
1. Diet and precautions:
Elevating the head of the bed or raising it high. sleeping on a pillow,
Staying away from food and drinks except water for at least two hours before going to bed,
Avoiding belts, corsets, girdles and tight clothing that will tighten the abdomen,
Avoiding leaning forward,
Losing weight,
Diet (It is necessary to stay away from bitter, sour, pickle, spicy, fried, oily-paste foods, chocolate, citrus fruits, tea, coffee and cola),
Quitting smoking and alcohol.
2. Drug Treatment:
In addition to drugs that facilitate gastric emptying by increasing gastric movements and thus keeping the intra-gastric pressure low, they reduce stomach acidity and thus reduce the damage that will occur even if the stomach contents escape into the esophagus. Anti-inflammatory drugs are used. First, a 4-week drug treatment is started. If symptoms recur afterwards, drug treatment can be continued. The frequency and dosage of medication can be adjusted depending on the severity of the disease. If the complaints continue despite drug treatment or recur as soon as the treatment is stopped, it is necessary to confirm with endoscopy.
If there is laxity in the muscle under the esophagus while swallowing movements of the esophagus are normal in motility studies,
If there is no improvement in the patient's complaints or endoscopy findings despite using medication for a long time,
If the patient is not compliant with the treatment, do not use medication for a long time. If the patient refuses, has drug allergy or drug-related side effects, surgical treatment should be performed in these patients.
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